Greenfield

84 timestamped statements across 3 topics — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Featured statements

▶ Ep 1 · 7:00
Quoting rates of complete resection or gross total resection are not really as important in these populations as they might be in adult literature, where sometimes the goal here really is decompression, preservation of function, and allowing the child to develop normally for another period of time before other therapy is instituted.
quote · Craniopharyngioma
▶ Ep 1 · 0:00
The goal of surgery in the pediatric population is sometimes very different than it is in the adult population, whereas sometimes gross total resection is the goal in an adult. Sometimes a biopsy followed by radiation is the, uh, is the algorithm or paradigm that we're aiming for in craniopharyngioma.
quote · Craniopharyngioma
▶ Ep 3 · 16:25
The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges.
clinical · Ependymoma
▶ Ep 3 · 11:40
The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque.
clinical · Ependymoma
▶ Ep 24 · 7:00
In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy.
clinical · Pediatric Oncology
▶ Ep 24 · 11:40
For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging.
clinical · Pediatric Oncology

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Greenfield's statements about Craniopharyngioma 28 statements

Open the Craniopharyngioma collection →

Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...

▶ Ep 1 · 0:00
clinical The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal. ↗
▶ Ep 1 · 0:00
quote The goal of surgery in the pediatric population is sometimes very different than it is in the adult population, whereas sometimes gross total resection is the goal in an adult. Sometimes a biopsy followed by radiation is the, uh, is the algorithm or paradigm that we're aiming for in craniopharyngioma. ↗
▶ Ep 1 · 0:00
quote really the only limits um are the putting together of a team uh and thinking creatively about how to utilize all of the tools and techniques that we have at our disposal. ↗
▶ Ep 1 · 7:00
clinical Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches. ↗
▶ Ep 1 · 7:00
quote Quoting rates of complete resection or gross total resection are not really as important in these populations as they might be in adult literature, where sometimes the goal here really is decompression, preservation of function, and allowing the child to develop normally for another period of time before other therapy is instituted. ↗
▶ Ep 1 · 7:00
quote just because you have a tool, it's not necessarily the right one. ↗
▶ Ep 1 · 7:00
clinical Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure. ↗
▶ Ep 1 · 7:00
clinical The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults. ↗
▶ Ep 1 · 7:00
clinical In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy. ↗
▶ Ep 1 · 7:00
clinical Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects. ↗
▶ Ep 1 · 7:00
clinical Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium. ↗
▶ Ep 1 · 11:40
clinical For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging. ↗
▶ Ep 1 · 11:40
quote This essentially is why we do this type of surgery, um, through the skull base. ↗
▶ Ep 1 · 11:40
clinical The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque. ↗
▶ Ep 1 · 11:40
clinical Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case. ↗
▶ Ep 1 · 11:40
quote This has been, um, uh, a very interesting transition. I'm sorry, my slides are advancing there. A very interesting transition from, um, what was traditionally a trans-oral approach, um, over the past several decades to what is exclusively now an endoscopic endonasal approach, uh, in our practice. ↗
▶ Ep 1 · 11:40
quote We use live uh brain lab continually to give us guidance. The anatomy is not always intuitive here. ↗
▶ Ep 1 · 11:40
clinical The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice. ↗
▶ Ep 1 · 11:40
clinical Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations. ↗
▶ Ep 1 · 11:40
clinical Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection. ↗
▶ Ep 1 · 11:40
clinical The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach. ↗
▶ Ep 1 · 11:40
clinical One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak. ↗
▶ Ep 1 · 11:40
clinical In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery. ↗
▶ Ep 1 · 11:40
clinical A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique. ↗
▶ Ep 1 · 16:25
clinical The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges. ↗
▶ Ep 1 · 16:25
quote It turns out that it's probably better to do it as a staged procedure. Um, it's simpler for the child to do it once, but in terms of the amount of, um, equipment needed for both of those procedures, the flow in the operating room, it ends up being a 10 to 12 hour day. Um, and no one's happy, you know, doing that type of delicate surgery at the end of a long day. ↗
▶ Ep 1 · 18:29
clinical There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces. ↗
▶ Ep 1 · 18:29
clinical The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases. ↗
Greenfield's statements about Ependymoma 28 statements

Open the Ependymoma collection →

Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...

▶ Ep 3 · 0:00
clinical The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal. ↗
▶ Ep 3 · 0:00
quote The goal of surgery in the pediatric population is sometimes very different than it is in the adult population, whereas sometimes gross total resection is the goal in an adult. Sometimes a biopsy followed by radiation is the, uh, is the algorithm or paradigm that we're aiming for in craniopharyngioma. ↗
▶ Ep 3 · 0:00
quote really the only limits um are the putting together of a team uh and thinking creatively about how to utilize all of the tools and techniques that we have at our disposal. ↗
▶ Ep 3 · 7:00
quote Quoting rates of complete resection or gross total resection are not really as important in these populations as they might be in adult literature, where sometimes the goal here really is decompression, preservation of function, and allowing the child to develop normally for another period of time before other therapy is instituted. ↗
▶ Ep 3 · 7:00
clinical The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults. ↗
▶ Ep 3 · 7:00
clinical Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure. ↗
▶ Ep 3 · 7:00
clinical Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects. ↗
▶ Ep 3 · 7:00
clinical Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches. ↗
▶ Ep 3 · 7:00
clinical Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium. ↗
▶ Ep 3 · 7:00
clinical In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy. ↗
▶ Ep 3 · 7:00
quote just because you have a tool, it's not necessarily the right one. ↗
▶ Ep 3 · 11:40
quote This has been, um, uh, a very interesting transition. I'm sorry, my slides are advancing there. A very interesting transition from, um, what was traditionally a trans-oral approach, um, over the past several decades to what is exclusively now an endoscopic endonasal approach, uh, in our practice. ↗
▶ Ep 3 · 11:40
clinical A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique. ↗
▶ Ep 3 · 11:40
clinical The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach. ↗
▶ Ep 3 · 11:40
clinical In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery. ↗
▶ Ep 3 · 11:40
clinical One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak. ↗
▶ Ep 3 · 11:40
clinical The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque. ↗
▶ Ep 3 · 11:40
clinical For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging. ↗
▶ Ep 3 · 11:40
clinical Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case. ↗
▶ Ep 3 · 11:40
quote We use live uh brain lab continually to give us guidance. The anatomy is not always intuitive here. ↗
▶ Ep 3 · 11:40
quote This essentially is why we do this type of surgery, um, through the skull base. ↗
▶ Ep 3 · 11:40
clinical The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice. ↗
▶ Ep 3 · 11:40
clinical Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations. ↗
▶ Ep 3 · 11:40
clinical Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection. ↗
▶ Ep 3 · 16:25
clinical The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges. ↗
▶ Ep 3 · 16:25
quote It turns out that it's probably better to do it as a staged procedure. Um, it's simpler for the child to do it once, but in terms of the amount of, um, equipment needed for both of those procedures, the flow in the operating room, it ends up being a 10 to 12 hour day. Um, and no one's happy, you know, doing that type of delicate surgery at the end of a long day. ↗
▶ Ep 3 · 18:29
clinical The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases. ↗
▶ Ep 3 · 18:29
clinical There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces. ↗
Greenfield's statements about Pediatric Oncology 28 statements

Open the Pediatric Oncology collection →

Relevance of Skull Base Surgery to Pediatric Neurosurgery: Pediatric...

▶ Ep 24 · 0:00
clinical The goal of surgery in craniopharyngioma in the pediatric population is sometimes biopsy followed by radiation, different from adult paradigms where gross total resection may be the goal. ↗
▶ Ep 24 · 0:00
quote The goal of surgery in the pediatric population is sometimes very different than it is in the adult population, whereas sometimes gross total resection is the goal in an adult. Sometimes a biopsy followed by radiation is the, uh, is the algorithm or paradigm that we're aiming for in craniopharyngioma. ↗
▶ Ep 24 · 0:00
quote really the only limits um are the putting together of a team uh and thinking creatively about how to utilize all of the tools and techniques that we have at our disposal. ↗
▶ Ep 24 · 7:00
quote Quoting rates of complete resection or gross total resection are not really as important in these populations as they might be in adult literature, where sometimes the goal here really is decompression, preservation of function, and allowing the child to develop normally for another period of time before other therapy is instituted. ↗
▶ Ep 24 · 7:00
quote just because you have a tool, it's not necessarily the right one. ↗
▶ Ep 24 · 7:00
clinical Intraventricular endoscopy has limitations including subpar optics compared to air medium and issues with hemorrhage obscuring the view in a fluid medium. ↗
▶ Ep 24 · 7:00
clinical The pathology of craniopharyngioma in children is very different molecularly and genetically than it is in adults. ↗
▶ Ep 24 · 7:00
clinical In pediatric skull base surgery, the goal is sometimes biopsy or subtotal resection rather than gross total resection, with the aim of decompression, preservation of function, and allowing normal development before other therapy. ↗
▶ Ep 24 · 7:00
clinical Endoscopic-assisted approaches in an air medium provide much better optics and the ability to do bimanual manipulation of tissues compared to fluid-medium intraventricular approaches. ↗
▶ Ep 24 · 7:00
clinical Five key considerations for endoscopic cases in children are: nasal aperture size (can limit bimanual operation), pneumatization, skull maturation, intercarotid distance, and defect closure. ↗
▶ Ep 24 · 7:00
clinical Pediatric skull base lesions can be categorized into four groups: benign neoplastic lesions, malignant neoplastic lesions, congenital malformations, and iatrogenic or traumatic defects. ↗
▶ Ep 24 · 11:40
clinical A linear incision in the retropharyngeal fascia works well for transodontoid approach, as long as suction is used to retract contralateral soft tissue; this replaced an earlier U-shaped incision technique. ↗
▶ Ep 24 · 11:40
clinical In the speaker's series of 10 odontoid resection patients, all are extubated on day 0 or 1, with early extubation now attempted on the same day of surgery. ↗
▶ Ep 24 · 11:40
clinical The transclival transodontoid approach has transitioned from a traditional transoral approach to what is exclusively now an endoscopic endonasal approach in the speaker's practice. ↗
▶ Ep 24 · 11:40
clinical Advantages of the endoscopic endonasal approach for odontoid resection include the ability to extubate early and begin feeding early, seen in both adult and pediatric populations. ↗
▶ Ep 24 · 11:40
clinical Odontoid resections are almost always done in conjunction with posterior fossa decompression and cervical instrumentation because of the instability that ensues from odontoid resection. ↗
▶ Ep 24 · 11:40
clinical The closure for transodontoid approach is simple: flow seal in the cavity and re-approximation of retropharyngeal fascia with one or two single interrupted stitches through a single nasal approach. ↗
▶ Ep 24 · 11:40
clinical One early reintubation in the odontoid series was due to aspiration of a sealant, which is no longer used because it was redundant and unnecessary due to lack of CSF leak. ↗
▶ Ep 24 · 11:40
clinical The odontoid resection patient population is very select: children with cervicomedullary angles approximating 100 degrees and Grabb-Oakes measurements in the 10-15 millimeter or larger range, representing significant brainstem compression and torque. ↗
▶ Ep 24 · 11:40
clinical For right-handed surgeons coming from the right nare in odontoid resection, there is a tendency to leave the very tip of the odontoid or the left side of the dens because getting to the contralateral side is challenging. ↗
▶ Ep 24 · 11:40
clinical Pre-operative CTA or MRA is sometimes part of the workup for odontoid resection to identify and navigate the carotid arteries throughout the case. ↗
▶ Ep 24 · 11:40
quote This has been, um, uh, a very interesting transition. I'm sorry, my slides are advancing there. A very interesting transition from, um, what was traditionally a trans-oral approach, um, over the past several decades to what is exclusively now an endoscopic endonasal approach, uh, in our practice. ↗
▶ Ep 24 · 11:40
quote We use live uh brain lab continually to give us guidance. The anatomy is not always intuitive here. ↗
▶ Ep 24 · 11:40
quote This essentially is why we do this type of surgery, um, through the skull base. ↗
▶ Ep 24 · 16:25
quote It turns out that it's probably better to do it as a staged procedure. Um, it's simpler for the child to do it once, but in terms of the amount of, um, equipment needed for both of those procedures, the flow in the operating room, it ends up being a 10 to 12 hour day. Um, and no one's happy, you know, doing that type of delicate surgery at the end of a long day. ↗
▶ Ep 24 · 16:25
clinical The practice initially performed staged odontoid resection and fusion procedures (instrumentation/decompression on Monday, endonasal resection on Wednesday) to avoid additive morbidity, then moved to one-day procedures, but now prefers staged procedures again because single-day cases become 10-12 hour days with equipment and flow challenges. ↗
▶ Ep 24 · 18:29
clinical There is a steep learning curve for endoscopic endonasal surgery in young children due to ergonomic challenges of getting the scope and two instruments working together in tight spaces. ↗
▶ Ep 24 · 18:29
clinical The practice has not yet incorporated a sublabial approach to the sphenoid sinus in pediatric cases. ↗